[Peroral endoscopic full and partial-thickness myotomy. A viability study in an animal model]. / Miotomía endoscópica por vía oral de espesor total y parcial. Estudio de factibilidad en un modelo animal.

BACKGROUND: Peroral endoscopic myotomy has recently been developed and performed on patients with good results. AIMS: To evaluate the technical feasibility of peroral endoscopic full-thickness and partial thickness myotomy in a porcine model. MATERIAL AND METHODS: Eighteen criollo pigs were randomly assigned to 2 groups: group A (partial-thickness myotomy) and group B (full-thickness myotomy). The mucosal defect proximal to the myotomy site was left open. On the seventh postoperative day the pig was euthanized and follow-up surgical exploration was performed. The duration of each procedure, postoperative progression of the animal, complications, and anatomopathologic findings were registered. RESULTS: The procedure was viable in all the pigs. The mean surgery duration was 81±35.3min (group A 51.11±11.12, group B 111±22.61; P<.05). The main complication during myotomy was subcutaneous emphysema (16%). The histopathologic study of the group A surgical specimens reported complete circular myotomy in all cases, and complete circular and longitudinal myotomy was reported in 100% of the group B sample. CONCLUSIONS: The endoscopic myotomy technique is feasible. Endoscopic partial-thickness myotomy was associated with shorter surgery duration and better results during the intraoperative period and the 7-day follow-up.

[Anatomic variants of biliary ducts detected by endoscopio colangiography]. / Variantes anatómicas de la vía biliar por colangiografía endoscópica.

INTRODUCTION: The gallbladder and bile ducts originate through a complex process during the 4th gestational week; there is a wide variety in their anatomy. OBJECTIVE: To identify the type, frequency, and association with certain pathologies of anatomic variations of bile ducts in patients in which endoscopic retrograde colangiography (ERC) was performed. METHODS: Six hundred and six patients in whom ERCs were performed from 2005 to 2007 in the Endoscopio Unit at the Hospital General Dr. Manuel Gea González in Mexico City were included. Variations in bile duct anatomy seen in the X-ray taken during ERC were identified. Demographic characteristics of the patients, indications of the study, complications, treatments, and type of anatomic variant were registered. Descriptive statistics were used to analyze the information. X2 and Fisher´s exact test were also performed for the comparison between patients with and without anatomic variations. RESULTS: We identified biliary anatomic variations in 5.1% of patients in the study. Among them, seventy- seven per cent were women, with a mean age of 41 years. The anatomic variation most frequently found was a low union of the cystic duct with the common hepatic duct. The main diagnosis during ERC was choledocholithiasis in 71% of patients. Bile duct injuries were found in only 3.2% of patients with anatomic variations. CONCLUSIONS: Anatomic variations in bile ducts identified by ERC are frequent in Mexican population; nevertheless they were not associated with the occurrence of bile duct injuries.